Angiogenic factors for the prediction of pre-eclampsia in women with abnormal midtrimester uterine artery Doppler velocimetry

Diab, Abd El-Aziz A.; El-Behery, Manal M.; Ebrahiem, Moustafa A.; Shehata, Amal E.

doi:10.1016/j.ijgo.2008.02.016

Cited by 75 publications

(53 citation statements)

References 23 publications

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“…Since these first publications, a multitude of clinical studies has established the ability of these markers to accurately diagnose and predict preeclampsia [72,73,74,75,76]. Meanwhile, automated tests are available to test for the condition in the clinical setting [77,78,79] (fig.…”

Section: Clinical Role In the Diagnosis And Management Of Preeclampsiamentioning

confidence: 99%

Update on the Pathophysiological Implications and Clinical Role of Angiogenic Factors in Pregnancy

2015

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Angiogenic markers are now being incorporated into clinical practice for the screening, diagnosing, and monitoring of preeclampsia. Pregnancy requires both vasculogenesis and angiogenesis in the fetal compartment and angiogenesis in the maternal compartment. Abnormal angiogenesis in the placenta determines impaired remodeling of the maternal spiral arteries and placental underperfusion that may ultimately lead to fetal growth restriction and maternal preeclampsia. The dysregulation of angiogenesis in the placenta and maternal-fetal circulation has emerged as one of the main pathophysiological features in the development of placental insufficiency and its clinical consequences. Abnormal angiogenesis has also been related to other obstetric and fetal conditions such as peripartum cardiomyopathy and fetal cardiac defects. This opens up new challenges for our understanding of angiogenic involvement in maternal cardiovascular function and fetal cardiac development, and it offers new clinical opportunities. This review summarizes the current knowledge of the pathophysiological implications and the clinical role of angiogenic factors in pregnancy.

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Section: Clinical Role In the Diagnosis And Management Of Preeclampsiamentioning

confidence: 99%

Update on the Pathophysiological Implications and Clinical Role of Angiogenic Factors in Pregnancy

2015

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“…Two nested case-control studies from the Calcium for Preeclampsia Prevention trial conducted by Levine et al [12,25] reported promising ORs for the diagnosis of preeclampsia, but specifically for preterm preeclampsia, based on the maternal serum concentrations of sFlt1 and sEng (highest quartile) and PlGF (lowest quartile) in the second trimester. Since then, several studies have reported on the predictive accuracy of angiogenic factors in the first [14] and second trimester [16,32,37,41,42,45,46,[82][83][84][85][86] of pregnancy. Overall, the sensitivity, specificity, positive and negative likelihood ratios of PlGF, sVEGFR-1 and sEng for all cases of preeclampsia ranged between 59% and 100%, 43% and 100%, 1.4 to infinity, and 0.0 to 0.7, respectively (Conde-Agudelo A., Romero R., and Lindheimer M., in press).…”

Section: Angiogenic and Anti-angiogenic Factors In The Prediction Of mentioning

confidence: 99%

“…Yet, the diagnostic indices and ORs reported in recent studies that evaluated the sFlt1/PlGF ratio were similar to those reported for individual angiogenic factors alone. [37,41,42] Recently, two case-control studies [57,58] reported the diagnostic performance of these analytes at 11 to 13.9 weeks for prediction of preeclampsia. Baumann et al [57] measured the maternal serum concentrations of sFlt-1, sEng and PlGF in women with a normal pregnancy and patients who subsequently developed late-onset preeclampsia (>34 weeks).…”

Section: Angiogenic and Anti-angiogenic Factors In The Prediction Of mentioning

confidence: 99%

“…Indeed, patients with preeclampsia have higher plasma concentrations of sVEGFR-1 [7][8][9][10]12,13,16,21,22,24,27,29,29,31,33,34,39,41,42,46,48] and sEng [25,30,[34][35][36]42,45,46,48] and lower plasma concentration of VEGF [8,49] and PlGF [3,5,6,8,11,12,14,27,29,33,38,39,41,42,46,[49][50][51] than patients with normal pregnancies at the time of the clinical diagnosis of preeclampsia. These differences have been observed even before the clinical presentation of the disease.…”

Section: Introductionmentioning

confidence: 99%

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A prospective cohort study of the value of maternal plasma concentrations of angiogenic and anti-angiogenic factors in early pregnancy and midtrimester in the identification of patients destined to develop preeclampsia

Kusanovic¹,

Romero²,

Chaiworapongsa³

et al. 2009

DJMF

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OBJECTIVE-Changes in the maternal plasma concentrations of angiogenic (such as PlGF and VEGF) and anti-angiogenic factors (such as sEng and sVEGFR-1) precede the clinical presentation of preeclampsia. This study was conducted to examine the role of maternal plasma PlGF, sEng and sVEGFR-1 concentrations in early pregnancy and midtrimester in the identification of patients destined to develop preeclampsia.METHODS-This longitudinal cohort study included 1,622 consecutive singleton pregnant women. Plasma samples were obtained in early pregnancy (6-15 weeks) and midtrimester (20-25 weeks). Maternal plasma PlGF, sEng and sVEGFR-1 concentrations were determined using sensitive and specific immunoassays. The primary outcome was the development of preeclampsia. Secondary outcomes included term, preterm and early-onset preeclampsia. Receiving operating characteristic (ROC) curves, sensitivity, specificity, positive and negative likelihood ratios, and multivariable logistic regression were used for statistical analyses. A p-value of <0.05 was considered significant. RESULTS-1)The prevalence of preeclampsia, term, preterm (<37 weeks) and early-onset preeclampsia (<34 weeks) was 3.8% (62/1,622), 2.5% (40/1,622), 1.4% (22/1,622) and 0.6% (9/1,622), respectively; 2) Higher likelihood ratios were provided by ratios of midtrimester plasma concentrations of PlGF, sEng, and sVEGFR-1 than single analytes; 3) Individual angiogenic and anti-angiogenic factors did not perform well in the identification of preeclampsia as a whole; in particular, they perform poorly in the prediction of term preeclampsia; 4) In contrast, a NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript combination of these analytes such as the PlGF/sEng ratio, its delta and slope had the best predictive performance with a sensitivity of 100%, a specificity of 98%-99%, and likelihood ratios for a positive test of 57.6, 55.6 and 89.6, respectively, for predicting early-onset preeclampsia. CONCLUSIONS-1)The PlGF/sEng ratio and its delta and slope had an excellent predictive performance for the prediction of early-onset preeclampsia, with very high likelihood ratios for a positive test result and very low likelihood ratios for a negative test result; and 2) Although the positive likelihood ratios are high and the positive predictive values low, the number of patients needed to be closely followed is 4:1 for the PlGF/sEng ratio and 3:1 for the slope of PlF/sEng.

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“…Only a few studies have examined combination tests. [18][19][20] Diab et al 18 performed a study in pregnant women at 23 weeks of gestation with abnormal uterine artery Doppler. When using abnormal uterine artery Doppler with a plasma sFlt-1 level greater than 614 pg ml À1 , the sensitivity, specificity, PPV and negative predictive value (NPV) were 96, 87, 76 and 98%, respectively.…”

Section: Introductionmentioning

confidence: 99%

Combination of plasma-soluble fms-like tyrosine kinase 1 and uterine artery Doppler for the prediction of preeclampsia in cases of elderly gravida

Kulmala

Phupong

2014

Hypertens Res

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The aim of this study was to determine the predictive value of the combination of plasma-soluble fms-like tyrosine kinase 1 (sFlt-1) and uterine artery Doppler for the detection of preeclampsia in women of advanced age at 16-18 weeks of gestation and to identify associations between other pregnancy complications and abnormalities of these combined tests. The maternal plasma sFlt-1 level was measured, and uterine artery Doppler was performed at 16-18 weeks of gestation in 314 cases of elderly gravida. The main outcome was preeclampsia. Fourteen women (4.46%) developed preeclampsia. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of uterine artery Doppler combined with plasma sFlt-1 for preeclampsia prediction were 28.6, 95.7, 23.5 and 96.6%, respectively. For the prediction of early-onset preeclampsia, the sensitivity, specificity, PPV and NPV were 80, 95.8, 23.5 and 99.7%, respectively. Patients with abnormal uterine artery Doppler findings and an abnormal plasma s Flt-1 level (greater than 1724.5 pg ml(-1)) had a higher risk of preterm delivery (relative risk (RR)=3.38, 95% confidence interval (CI) 1.47-7.59), neonatal respiratory distress syndrome (RR=52.06, 95% CI 5.71-474.45) and perinatal death (RR=17.35, 95% CI 1.13-265.64). Our findings indicate that the combination of uterine artery Doppler and sFlt-1 level at 16-18 weeks of gestation in cases of elderly gravida has a high predictive value for early-onset preeclampsia, but not for overall preeclampsia. This combination test may be a useful early second trimester screening test for the prediction of early-onset preeclampsia in cases of elderly gravida.

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Angiogenic factors for the prediction of pre-eclampsia in women with abnormal midtrimester uterine artery Doppler velocimetry

Abstract: Measuring uterine perfusion and angiogenic factors concurrently in the second trimester improved the prediction of pre-eclampsia and IUGR.

Cited by 75 publications

References 23 publications

Update on the Pathophysiological Implications and Clinical Role of Angiogenic Factors in Pregnancy

Update on the Pathophysiological Implications and Clinical Role of Angiogenic Factors in Pregnancy

A prospective cohort study of the value of maternal plasma concentrations of angiogenic and anti-angiogenic factors in early pregnancy and midtrimester in the identification of patients destined to develop preeclampsia

Combination of plasma-soluble fms-like tyrosine kinase 1 and uterine artery Doppler for the prediction of preeclampsia in cases of elderly gravida

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